5 Obesity is a disease with a Genetic PredispositionPSYCHO-LOGICALDIS.SOCIO-ECOMOMICSEATING DIS.HORMONALIMBALANCEWILLPOWERGENETICThe exact method of genetic translation is not known at this time. TheExpression of obesity varies with social, cultural, environmental, economicand psychological influences.

7 NIH Consensus Statements 1991Prolonged and sustained weight loss has not bee proven with drug therapy.*Published studies of medical approaches to treatment of obesity include few reports or indications of efficacy in person with clinically severe obesity.Evidence of long-term efficacy of behavior modification in persons with clinically severe obesity is lacking.VLDC's used under close medical supervision generally have not been successful for achieving permanent weight loss.

8 Surgical Treatment and Management of ObesitySurgical Treatment is the only treatment that provides effective long-term controlGastric Bypass/Banded Gastric bypassGastroplasty/Sleeve GastrectomyGastric BandingBilio-pancreatic Diversion with or without a SwitchIntestinal Bypass

22 Why the Banded Gastric Bypass Historical and Experimental Data:There are eight series with long term (6-14years) follow-up documenting 70+ PEWL and weight loss maintenance in more patients, even the old and super obeseCapella, USA, AJS; Fobi, USA, SOARD; White, New Zealand, Obes Surg; Salinas, Venuzuela SOARD; D.Margo, Obes Surg; Mali, Obes Surg; Cruz, Obes Surg; and Awad, Obesity Surgery 2012There are only six long term series reported with the non-banded gastric bypass with an average of 55 PEWL, except Sutter with 70+ PEWLPories, Sutter, Dinitz, Christou, Higa, and the Swedish study22

23 % EWL Banded vs Non Banded Gastric Bypass Awad et al Obes. Surg. 201283,5(45-115)There is a significative difference in %EWL at month. We followed the banded patients for 10 and 12 years and they maintaing the same %EWL. We do not know about the non banded because we started to do it latter.61,5(27-109)There is a significative difference in %EWL at month. We followed the banded patients for 10 and 12 years and they maintained the same %EWL.Presented at IFSO_LAC Congress Cartagenia, Columbia, March 2011

27 BGBP vs. GBP Schauer and Associates at the Cleveland ClinicPresented Prospective Evaluation with two year follow-up at IFSO Congress in Hamburg (2011)Showed more weight loss and maintenance with the BGBP

32 ( E.Mason, Obesity Surgery 1994; 4:66-72)Banding the Pouch in GBP“Since Roux-en-Y Gastric Bypass is primarily a restriction operation, just as with VBG, it is important that the outlet of the pouchdoes not stretch.”( E.Mason, Obesity Surgery 1994; 4:66-72)

33 MacLean, J Am Coll Surg 97; 185:1-7Banded Gastric BypassAt this time, the most promising technique based on a large series is that described by Capella and Capella, the “Banded Gastric Bypass”MacLean, J Am Coll Surg 97; 185:1-733

34 Gastric Bypass OperationWhy the Band in theGastric Bypass OperationFisher after an in depth review concluded that “Long-term results suggest that a silastic ring encircling the stomach pouch proximal to the gastroenterostomy may improve the outcome following gastric bypass surgery, resulting in more weight loss by a greater number of patients sustained for a longer time”- Fisher BL, Barber AE, Eur J Gatroenterol Hepatol 1999; 11:93-97